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Women in northern Nigeria have an average of more than seven babies. But nurse Aisha Saraki knows why she and her colleagues in the maternity ward at one of northern Nigeria’s biggest hospitals are not busier these days. “There is no money,” she begins, referring to the economic recession battering Africa’s biggest oil producer. “And they want something to eat,” she says of expectant mothers in the area.

Increasingly, women in the northern city of Gusau are choosing to save money by having their babies at home. A trouble-free delivery at the privately owned hospital costs the equivalent of $11, according to Saraki. That makes a hospital delivery unaffordable for most Nigerians. A UN study last year found that more than 60 per cent of the population live on $1.25 a day.

A growing economic crisis, amid already severe poverty in places such as Gusau, is the latest obstacle to efforts to rein in maternal mortality. But it is far from the only factor. Deeply rooted cultural and religious norms in the conservative north influence how many years of schooling girls and young women are allowed before marriage. Most girls in the impoverished north-west give birth in their mid-teens, according to the Demographic and Health Surveys Program, the US data provider.

We need to reduce our population now because we are facing huge economic challenges

Nigeria has one of the highest maternal mortality rates in the world — 814 deaths per 100,000 live births. According to the UN, the country makes up about 2 per cent of the world’s population but 10 per cent of total maternal deaths. Underlying these figures are deep disparities between the regions.

The country’s commercial capital, Lagos, is a centre of innovation in the continent’s tech start-up world. But a woman’s chance of dying a pregnancy-related death in Nigeria is one in 13, according to the UN, while just one-third of deliveries are with skilled birth attendants.

Public health experts say that, in northern Nigeria in particular — which is far less developed and prosperous than the south — studies show that women are having more children than they say they want to. This is a sign they may not have access to family planning options, control over their reproductive lives or the chance to make any decisions at all about their lives.

814

maternal deaths per 100,000 live births

“It’s not just about family planning alone,” says Babatunde Osotimehin, executive director of the UN Population Fund. “It’s also ensuring women and girls are empowered with education.” He says UN agencies are engaging with political, religious and traditional leaders in the north in particular to find “champions within society who understand what we are trying to do”.

While some traditional leaders have begun to speak publicly about the importance of family planning and “spacing” for the sake of a mother’s health and that of her future children, politicians from the northern region are loath to speak up on a personal matter that is entwined with culture and religion.

109

deaths of children under five per 1,000 live births

“The political elite are the missing bit of the jigsaw,” says a development official in Abuja, who did not want to be named.

Some of the few people who are willing to speak directly are female students who are trying to beat the odds by staying in school. “We need to reduce our population now because we are facing huge economic challenges,” says Zainab Garba Jijji, aged 17. “Having 30 children in a house is not good. The government needs to tell people the truth.”

Saraki, the nurse, agrees but says financial strains caused by low oil prices will slow the government’s progress on critical issues such as education for girls, who will get married young and begin having high-risk pregnancies if they do not stay in school. “Through education, women are now understanding the problems they’ll suffer” from home deliveries and multiple pregnancies in rapid succession, she says.